Quality measurement is a well-known concept in the healthcare landscape. For over two decades, healthcare leaders have created quality measures that resulted in transparency, accountability, and improvement. One of the most well-known uses of quality measures is on Medicare’s Care Compare website, where providers are rated according to their performance in various clinical outcomes. Different quality measure sets have been developed over the years to best reflect outcomes in various clinical settings. For example, hospital measures may include performance metrics related to surgeries, emergency care, and various outcomes of inpatient care. Examples of nursing home measures include performance metrics of patient care, including indicators of pain, pressure injuries, and antipsychotic use.
As the measures expanded over time and were used for different purposes, many found the measures confusing, burdensome for providers due to increased reporting requirements, and potentially harmful by leading to irregularities in clinical care. With many measures linked to value-based reimbursement programs in recent years and consumer tools such as Care Compare becoming widely available, having a reliable set of quality measures has become more important than ever.
Although CMS and other entities have made progress toward aligning the agency’s quality programs, there is still room for improvement. Currently, there is no indication that Care Compare or other uses of quality measures will be discontinued. However, the Universal Foundation will establish which measures are most meaningful across populations and programs. These re-aligned measures will help CMS better understand what is most effective for quality improvement.
The Universal Foundation is based on streamlined measures identified through specific selection criteria to refocus the attention of providers, payers, insurers, and others. The measures included in the Universal Foundation must meet the following criteria. To be included, Universal Foundation measures must be:
- of a high national impact;
- able to be benchmarked nationally and globally;
- applicable to multiple populations and settings;
- appropriate for stratification to identify disparity gaps;
- scientifically acceptable;
- feasible and computable (or capable of becoming digital); and
- free of unintended consequences.
The measures selected for the Universal Foundation will be used across as many CMS programs as possible, with further measures being added as needed based on the patient population or care setting. However, the Universal Foundation’s main intent is to focus on meaningful measures for broader population groups, which will help reduce provider burden with streamlined measures. The focus of these measures will also help CMS identify and track health disparities. Additionally, CMS is focused on transitioning quality measure reporting to an automatic digital reporting system.
As the Universal Foundation evolves, it is expected that more measures will be added across all programs, although some instances may require a particular measure to be added in only one program as specifically related to a certain setting. The selected quality measures correlate with diseases and conditions related to the highest morbidity and mortality rates in the U.S., such as high blood pressure, diabetes, and cancer. The Universal Foundation measures also relate to preventive care, identifying and treating mental and behavioral health conditions, and integrating holistic behavioral and physical health care. Finally, the measures reflect the significance of care coordination, patient experience, and social determinants of health.
CMS, “Aligning Quality Measures Across CMS – the Universal Foundation”
NEJM, “Aligning Quality Measures across CMS — The Universal Foundation”
